[NetBehaviour] The NHS and the blockchain

Wed Nov 2 19:51:23 CET 2016

Superb!
Thanks Edward -I've put this in my back pocket.
We should workshop this to find out everything that can go right and 
wrong for all stakeholders - from the patient to the politicians.

It would be nerdy bliss.

On 30/10/16 19:24, Edward Picot wrote:
> I've now made so many unsuccessful and partially-successful attempts 
> to get my head round the Blockchain concept that I'm starting to think 
> I might have some form of early dementia.
>
> However, there's one field in which I dimly understand what the 
> implications might be: namely, the health service, where I work. Since 
> the Labour government introduced the 'Payment by Results' system into 
> the NHS about fifteen years ago, and then the Conservative government 
> put groups of GPs (clinical commissioning groups, or CCGs) in charge 
> of local health budgets, there's been no end of muddle about how to 
> get good reliable statistics out of the system as regards which 
> patients are being treated where, what they're having done, how much 
> it's costing, and which health authorities they belong to. The 
> blockchain is probably an answer to this problem.
>
> Let's say a patient rings 999 one weekend because he's having a 
> heart-attack. The ambulance takes him to the local A&E department at 
> the Tunbridge Wells Hospital. He gets investigated, and after 
> investigation he gets transferred to St Thomas's Hospital in London 
> for a triple bypass. Then he's discharged to a Cottage Hospital in 
> Hawkhurst, and eventually back home.
>
> At each stage of the journey he has incurred costs. First of all the 
> ambulance trust charges for transporting him (once to the Tunbridge 
> Wells Hospital, then from Tunbridge Wells to the St Thomas' Hospital, 
> then back to the Cottage Hospital). Then his A&E attendance and 
> investigations in Tunbridge Wells will all incur costs (via the 
> Maidstone and Tunbridge Wells Hospital Trust); then his treatment and 
> stay in St Thomas's (via the Guys and St Thomas' Hospital Trust); and 
> finally his stay in the Cottage Hospital (which comes under the 
> Maidstone and Tunbridge Wells Hospital Trust again).
>
> Now, all of these costs and data about what treatments were carried 
> out, length of stay, drugs dispensed to the patient while in hospital, 
> etc, are supposed to find their way into our local health informatics 
> system, which is a big 'data silo', so that if we want to (or, more to 
> the point, if the CCG wants to) it's possible to 'drill down', as they 
> call it, and find, under the Cardiology costs for a particular 
> financial year, the treatment and costs for that particular patient as 
> a result of that particular health episode. The difficulty is that the 
> information has to be pulled in from various different trusts - our 
> local hospital, the hospital in London, and the local ambulance 
> service - and compliance varies from trust to trust. So the 
> information from our local hospital trust will probably be available 
> more or less straight away, the information from the ambulance trust a 
> bit more slowly, and the information from London a bit more slowly 
> again. Things can get even more complicated if our patient has his 
> heart attack while he's on holiday in Dorset - because all the costs 
> he incurs should still come back to the area in which he is a 
> registered patient, but of course a hospital in Dorset feeds back 
> information much more slowly to Kent than it would to its own health 
> authority. And things can also get more confusing if parts of the 
> patient journey, while still chargeable to the NHS, are carried out by 
> one of the private hospitals - let's say the patient, instead of 
> having a heart attack, has a cataract operation at a private hospital, 
> which is doing cataract operations on an NHS contract as part of the 
> Any Qualified Provider arrangements. The private hospital may not have 
> good arrangements in place for feeding back data into the NHS system.
>
> A big part of the problem is that you've got all these different 
> organisations operating within the NHS - hospital trusts, ambulance 
> trusts, CCGs, individual surgeries, private hospitals etc. - and 
> they've all got their own bespoke computer systems with their own 
> bespoke ways of recording patient data, and it's a constant struggle 
> to get them to talk to one another. A blockchain distributed ledger 
> would surely be an improvement on the existing system. You'd just have 
> to enter a transaction onto the blockchain every time you performed 
> some kind of service for a patient - anything from a prescription for 
> paracetamol to a hip replacement - and as soon as the transaction was 
> recorded the information would be available from one end of the system 
> to the other, with the costs correctly allocated both to that 
> particular patient and to the patient's own health authority. Of 
> course you'd also have to record the same event on the patient's 
> clinical records, in order to keep an accurate clinical history, so 
> you'd either have to enter it twice, once on the clinical record and 
> once on the blockchain, or (much better) you'd have to get every 
> clinical system in the country to communicate with the blockchain, 
> which would probably be a lot easier than trying to get them all to 
> talk to each other.
>
> So far so good. However, what do you do in the case of a patient where 
> you can't discover the NHS number, so you can't accurately say who the 
> patient is, where he's registered and where the costs ought to be 
> allocated? Let's say somebody's been run over in the street and is 
> taken to hospital unconscious, with no identification. Or let's say 
> it's somebody from abroad, or a refugee or illegal immigrant who has 
> never registered with a GP in this country. One option is to issue a 
> dummy NHS number and have some kind of 'miscellaneous' budget against 
> which the costs can be allocated. But the other option is to use the 
> system as a means of identifying people for whom the NHS doesn't have 
> to accept responsibility, and thus excluding or rejecting them. The 
> refugee, the illegal immigrant or the person from overseas, who 
> couldn't produce any evidence of valid NHS registration, wouldn't be 
> refused emergency treatment - not unless there was a really dramatic 
> change of philosophy - but if it was anything less than 
> life-threatening they might be turned away, or told that they could 
> only have treatment if they paid for it. And that's one of the 
> potential effects of the blockchain, as I understand it: it's so 
> efficient, that if you set the rules up in a certain way at the 
> outset, you'll end up disenfranchising people who are misfits of one 
> type or another. If you don't build some leeway into the system, you 
> can simply make it impossible for certain types of people to get 
> anything out of it. Presumably the same thing could happen to the 
> benefits system. And this, in turn, is likely to encourage a black 
> market. If you haven't got an NHS number, and therefore you can't get 
> treatment, the way round the problem is to steal somebody else's 
> identity.
>
> - Edward
>
> _______________________________________________
> NetBehaviour mailing list
> NetBehaviour at netbehaviour.org
> http://www.netbehaviour.org/mailman/listinfo/netbehaviour

-- 
Co-founder Co-director
Furtherfield

www.furtherfield.org

+44 (0) 77370 02879

Bitcoin Address 197BBaXa6M9PtHhhNTQkuHh1pVJA8RrJ2i

Furtherfield is the UK's leading organisation for art shows, labs, & 
debates
around critical questions in art and technology, since 1997

Furtherfield is a Not-for-Profit Company limited by Guarantee
registered in England and Wales under the Company No.7005205.
Registered business address: Ballard Newman, Apex House, Grand Arcade, 
Tally Ho Corner, London N12 0EH.